by Irma Moore | Jul 24, 2024 | Uncategorized
Who We Are
Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.
We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here.
Job SummaryUnder the direction of the Risk Adjustment Supervisor/Manager, performs accurate and timely review and validation of Medicare Advantage, Commercial and Medicaid HCCs through medical record reviews. The Risk Adjustment Coding Specialist III reviews provider documentation of ICD-10-CM (including ICD-9-CM) codes to verify that coding meets both established coding standards as well as CMS and ACA Risk Adjustment guidelines. The Coding Specialist III will lead efforts to evaluate the HCC coding practices and provide analyses and recommendations to improve overall provider documentation and coding. The Risk Adjustment Coding Specialist III will review medical records to determine if diagnostic codes (ICD-9/10-CM) are accurately reflecting the provider documentation. The Risk Adjustment Coding Specialist III coder will summarize findings for internal and external parties. The Coding Specialist III will work on a broad range of audit projects including those with high business impact and that require high levels of expertise and risk adjustment coding experience. The Coder III will at times perform quality control (QC) for the work performed by the Coder Specialist I and Coder Specialist II. They will provide guidance on accurate coding standards. The Coder III’s may also conduct coding and documentation training to network providers and their coding staff.
Key Responsibilities/Duties – what you will be doing
- Performs ongoing audit of medical records from coding vendor and network providers to ensure diagnosis coding accuracy.
- Performs medical record audit to determine coding accuracy to coding standards and CMS regulations.
- Evaluates medical records for appropriate written and electronic signatures as well as other technical requirements.
- Collaborates with THP staff and vendors to identify and submit coding adjustments, as needed. Performs HHS-RADV Audits to include preparing chart for Initial Validation Auditor (IVA).
- Evaluates results from IVA and when applicable, provides ICD-10-CM Guideline(s), AHA Coding Clinic and/or CMS Guidelines to support the validity of the ICD-10-CM code assignment.
- Participates in ad hoc coding projects and face-to-face and small groups provider coding review sessions.
- Maintains a current and strong understanding of coding rules and CMS guidelines in both inpatient and outpatient settings. Priority for the Risk Adjustment Coding Specialist III to compliantly interpret and incorporates ICD-10-CM and ICD-9-CM coding guidelines and CMS regulations. Incorporates changes to guidelines and regulations into audit work in a timely manner.
- Researches and resolves coding questions and risk adjustment regulatory issues.
Qualifications – what you need to perform the job
Completion of a formal coding certification program required. Certified Professional Coder (CPC-A, CPC, CPC-H, COC, CIC, or CRC) certification or Certified Coding Specialist (CCS-P or CCS) required. ICD-10-CM coding proficiency and CRC certification required.
7 or more years of coding experience is preferred. Coding experience in a health plan, hospital or physician practice, billing and/or hospital care management environment required. Prior experience with Risk Adjustment coding and auditing preferred (or 5 or more years in risk adjustment coding experience with provider facing role).
Compensation & Total Rewards Overview
As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company’s sole discretion and may be modified at the Company’s sole discretion, consistent with the law.
Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:
- Medical, dental and vision coverage
- Retirement plans
- Paid time off
- Employer-paid life and disability insurance with additional buy-up coverage options
- Tuition program
- Well-being benefits
- Full suite of benefits to support career development, individual & family health, and financial health
For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/
Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity
Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team’s strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
by Irma Moore | Jul 24, 2024 | Uncategorized
Facility:
Work From Home – Ohio
Department:
HIM – Professional Coding
Schedule:
Full time
Hours:
40
Job Details:
Provides auditing and monitoring of professional coding services. Will help serve as a liaison for regulatory and coding purposes with DCH coders and physician staff. Helps educate coders and physicians on appropriate and compliant ICD-10, CPT, and HCPCs selection, as well as education around documentation requirements.
Will routinely perform quality auditing on internal coding staff to identify educational opportunities that adhere to correct coding standards.
Department Specific Job Details:
Education:
High School Diploma/GED required
Associates degree in related healthcare or business preferred
Certification
Certified Professional Medical Auditor (CPMA), in current standing
or Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) in good standing
Experience (required)
+ 3 years of progressive experience in a similar role required; 5 years preferred.
Excellent communication skills. Basic computer knowledge with proficiency in Microsoft office applications. Knowledge and experience with medical billing / collections. Epic experience
Education Requirements:GED (Required), High School (Required)
Certification/License Requirements: Certified Professional Medical Auditor – AAPC, RHIA – Registered health Information Administrator – American Health Information Management Association, RHIT – Registered health Information Technician – American Health Information Management Association
by Irma Moore | Jul 24, 2024 | Uncategorized
Overview
Our team members are the heart of what makes us better.
At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.
Together, we keep getting better – advancing our mission to transform healthcare and serve as a leader of positive change.
The Inpatient Coder assigns the principal diagnosis, comorbidities, complications and chronic conditions for Hackensack Meridian Health (HMH) Inpatient cases across the network to the highest specificity utilizing currently mandated coding systems in accordance with Centers for Medicare and Medicaid Services (CMS) and other coding compliance regulations.
This position requires working every weekend and it’s 100% remote.
Responsibilities
A day in the life of a Inpatient Coder at Hackensack Meridian Health includes:
- Assigns International Classification of Diseases (ICD)-10-CM Clinical Modification (CM) and ICD-10-Procedure Coding System (PCS) codes creating diagnosis-related group (DRG) assignments. Abstracts pertinent information from patient records.
- Sequence the diagnosis and procedures using coding guidelines and optimizing the DRG as applicable.
- Addressing all edits, including but not limited to nosology, Exihauser, Patient Safety Indicators (PSI), hospital-acquired condition (HAC), and others as needed based on quality indicator.
- Apply reason/tracking code and rationale (if needed) in 3M as needed for DRG mismatches on Clinical Documentation Improvement (CDI) reviewed cases.
- Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous or unclear for coding purposes.
- Apply present on admission (POA) indicators on all inpatient charts.
- Keeps abreast of coding guidelines and reimbursement reporting requirements, new technology and procedures as well as CMS approved clinical trials. Brings identified concerns to the supervisor or department manager for resolution.
- Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
- Data enters coded/abstracted information for DRG assignment into the HMH designated computer system.
- Review Case Management notes and assign discharge disposition based on the disposition indicated by CM or email leadership when not present and or conflicting.
- Identifying missing operative/path reports/or any pertinent procedures in patients records at the time of coding. Notifying Discharged not final billed (DNFB) of missing reports required for coding.
- Participate in ongoing coding educational webinars routinely and as needed.
- Participate as needed in external departments and/or Contract vendors review/educational sessions to comply with legal and procedural policies, optimize reimbursement and adhering to regulations.
- Review individually audited cases by third party companies and provide a rebuttal if needed.
- Other duties and/or projects as assigned.
- Adheres to HMH Organizational competencies and standards of behavior.
Qualifications
Education, Knowledge, Skills and Abilities Required:
- High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
- Minimum of 3+ years of experience coding in an acute complex healthcare environment.
- Demonstrated expertise in Medical Terminology, Anatomy and Physiology, Pathophysiology, Pharmacology and inpatient coding.
- Encoder usage required with proficiency in computer skills.
- Excellent written and verbal communication skills.
- Proficient computer skills including but not limited to Microsoft Office and Google Suite platforms.
Education, Knowledge, Skills and Abilities Preferred:
- Associate’s level degree or higher in HIM, Allied health, or another related field.
Licenses and Certifications Required:
- Certified Coding Specialist.
Licenses and Certifications Preferred:
- Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT), or other Allied Health credential with inpatient coding experience.
If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!
by Irma Moore | Jul 24, 2024 | Uncategorized
Job Description
Day to Day:
Insight Global is looking for a Python developer to work remotely for one of its top financial clients. The team is working on migrating from mainframe to cloud. This team manages the lending related applications. The candidate needs to have knowledge of writing scripts in python and can understand mainframe programs. They will also be utilizing python scripts to convert into XML scripts. The candidate needs to have 5 years of experience with backend python development.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [email protected] .
To learn more about how we collect, keep, and process your private information, please review Insight Global’s Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ .
Skills and Requirements
Must Haves:
-5 years of development with Python
-Need someone with experience with Cloud (GCP)
-Containers (kubernetes)
-Complex SQL queries
-Bachelors Degree Plusses:
-Mainframe experience (Cobal and JCL) (older)
-GCP Certification null
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to [email protected].
by Irma Moore | Jul 24, 2024 | Uncategorized
The position is described below. If you want to apply, click the Apply Now button at the top or bottom of this page. After you click Apply Now and complete your application, you’ll be invited to create a profile, which will let you see your application status and any communications. If you already have a profile with us, you can log in to check status.
Need Help?
If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to Accessibility (accommodation requests only; other inquiries won’t receive a response).
Regular or Temporary:Regular
Language Fluency: English (Required)
Work Shift:1st shift (United States of America)
Please review the following job description:
- Produce reports or package of reports utilizing databases, data assets, applications and more to provide information to business leaders.
- Reports may be in the form of standardized dashboards or customized views of data upon request.
- Ensure data pulled is consistent with business needs/requests.
- Apply knowledge of the business to customize reports and deliver meaningful information.
- Review report to identify data integrity issues and provide feedback to application/database administrators to ensure any issues are addressed.
- Answer questions from end-users of reports to provide additional context.
- Reporting may be focused on regulatory matters, operational metrics, and productivity metrics
- Apply a comprehensive understanding of end-to-end data processes/flows and concepts to implement frameworks, processes, controls, models, and solutions to ensure data is effectively managed across the organization or within a specific business unit.
- Drive automation & process optimization with focus on process efficiency and effectiveness.
Requirements
- Must have Bachelor’s degree in Computer Engineering, Systems Engineering, IT or related technical field plus 5 years of progressive experience in Data Analyst or similar positions performing the following:
- Applying understanding of principles, practices, theories, and methodologies associated with data quality and information technology.
- Performing data extraction, cleaning, transformation, and manipulation.
- Demonstrating proficiency with: SQL, SAS, ETL Tools (Abinitio or Informatica), UNIX, Metadata Hub, Relational Databases (Oracle , SQL Server, and DB2), Data Warehousing and Dimension modelling, Erwin, Big Data, R, Tableau, and Cognos.
- In the alternative, employer will accept a Master’s degree in Computer Engineering, Systems Engineering, IT or related technical field plus 3 years of experience in Data Analyst or similar positions performing the aforementioned.
- Position may be eligible to work remotely but is based out of and reports to Truist offices in Charlotte, NC. Must be available to travel to Charlotte, NC regularly for meetings and reviews with manager and project teams within 24-hours’ notice.
General Description of Available Benefits for Eligible Employees of Truist Financial Corporation: All regular teammates (not temporary or contingent workers) working 20 hours or more per week are eligible for benefits, though eligibility for specific benefits may be determined by the division of Truist offering the position. Truist offers medical, dental, vision, life insurance, disability, accidental death and dismemberment, tax-preferred savings accounts, and a 401k plan to teammates. Teammates also receive no less than 10 days of vacation (prorated based on date of hire and by full-time or part-time status) during their first year of employment, along with 10 sick days (also prorated), and paid holidays. For more details on Truist’s generous benefit plans, please visit our Benefits site. Depending on the position and division, this job may also be eligible for Truist’s defined benefit pension plan, restricted stock units, and/or a deferred compensation plan. As you advance through the hiring process, you will also learn more about the specific benefits available for any non-temporary position for which you apply, based on full-time or part-time status, position, and division of work.
Truist supports a diverse workforce and is an Equal Opportunity Employer that does not discriminate against individuals on the basis of race, gender, color, religion, citizenship or national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law. Truist is a Drug Free Workplace.
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